The Anomalous Coronary Artery in Aortic Valve Replacement: A Case For Caution.

We report obstruction of an anomalous right coronary artery traversing between the pulmonary artery and aorta after placement of a 21-mm bovine bioprosthesis for critical aortic stenosis requiring emergency revascularization. Although this anomaly has been associated with sudden death syndrome, acute coronary ischemia resulting from aortic valve replacement in patients with anomalous coronary artery has not been sufficiently highlighted in the literature. Awareness of this issue may decrease the risk of this complication in patients with anomalous coronary anatomy undergoing aortic or pulmonary valve replacement. Furthermore, the need for careful preoperative imaging in patients undergoing semilunar valve replacement is essential.